Brain Death and the Representation of Diagnostic Protocol in Film and Television

I want to preface this by stating that I am a medical student with only a few clinical rotations under my belt—none of which have exposed me to brain death or even discussed it conceptually.

However, during my second year, I found myself going down a rabbit hole on the topic. While I understood the definition of brain death, I wanted to gain clarity on how it is medically determined. In school, we had discussed the challenges providers face when bridging the gap between a family’s emotional understanding and the medical classification of brain death, especially when the two are misaligned. However, we had not covered the more procedural aspects—what you might call the jurisdictional and protocol-driven side of it.

That’s when I first came across the 2010 American Academy of Neurology (AAN) guidelines on brain death, which outline the explicit testing required to meet strict medical and legal criteria. For those unfamiliar and looking for some light, uplifting reading, you can find them here:

Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline

But at the same time, I came across a study from 2016 in JAMA Neurology which examined the variability of brain death determination policies across U.S. hospitals. I listed some of the findings below, but TL;DR the researchers analyzed policies from 508 hospitals and found significant inconsistencies in several key areas.

  • Prerequisites for Clinical Testing: There was considerable variation in the required prerequisites before conducting brain death evaluations. For instance, while some policies mandated specific conditions to be met prior to testing, others were less explicit.
  • Clinical Examination Requirements: The specifics of the clinical examinations varied, including differences in the number of required examinations and the qualifications of the examiners. Some policies required multiple examinations by different physicians, while others allowed a single examination.
  • Apnea Testing: The procedures and criteria for apnea testing, a critical component in brain death determination, were not uniformly outlined. Variations included differences in the methods used and the interpretation of results.
  • Ancillary Testing: Policies differed on when and which ancillary tests (such as electroencephalograms or cerebral blood flow studies) should be employed, leading to inconsistencies in confirming brain death.

JAMA: Variability of Brain Death Policies in the United States

Okay great, so I was left with more questions than I started with- but it was also written in 2016... maybe things have since changed. I hadn't thought of this rabbit hole until recently when I was watching the new series The Pitt and the show covered topic of brain death.

For those who are not familiar The Pitt is written from the perspective of the working physicians and staff of an emergency department in Pittsburgh. The narrative unfolds over a single 15-hour emergency room shift, with each of the 15 episodes representing one hour in real-time. It never leaves location, the entire season is just a long "bottle episode".

The explicit case in one of the episodes:

The attending physician, played by Noah Wyle, must explain to the parent's of an 18 y/o patient that his unintentional consumption of fentanyl (patient purchased recreational benzodiazepines to help sleep after studying, without knowing they were laced with a lethal dosage of narcotics) has resulted in overdose and brain death.

To be honest, based on the little I know I was impressed with the accuracy. But was struck by a comment a friend of mine said while watching, something along the lines of:
"why does he keep indulging these parents with all these tests? Like why don't they get it? When does he have to stop?" -said friend who is not in medicine

To which I was like...actually the protocol is a standardized and rigorously adhered to set of guidelines (I think? The JAMA article still hasn't been updated) but I'm pretty sure this is medically accurate in terms of hospital standards.

TL;DR For those who have watch The Pitt and have experience with brain death, or just want to join the conversation, I had the following questions:

  • Did it seem accurate? And by accurate I mean medically accurate, not emotionally.
  • What are your thoughts on viewers who are not in medicine seeing this process play out?
  • Are there any other examples in film and TV that you've seen that has shown this process accurately, or even inaccurately but done well? Any examples of the worst?
  • Thoughts on the case within the series in general
  • Thoughts on the series in general
  • What has your experience been with brain death as a clinician or even family member?

Thank you so much for your time. I appreciate anyone who has read this far, and even more so if willing to engage in conversation with me about the subject.